EP2155071B1 - Medical devices and systems for closing perforations - Google Patents
Medical devices and systems for closing perforations Download PDFInfo
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- EP2155071B1 EP2155071B1 EP08756124.7A EP08756124A EP2155071B1 EP 2155071 B1 EP2155071 B1 EP 2155071B1 EP 08756124 A EP08756124 A EP 08756124A EP 2155071 B1 EP2155071 B1 EP 2155071B1
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- medical device
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- 238000000034 method Methods 0.000 description 8
- 238000012986 modification Methods 0.000 description 3
- 230000004048 modification Effects 0.000 description 3
- 230000009278 visceral effect Effects 0.000 description 3
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- 230000002498 deadly effect Effects 0.000 description 1
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- 230000002496 gastric effect Effects 0.000 description 1
- 210000001035 gastrointestinal tract Anatomy 0.000 description 1
- 208000015181 infectious disease Diseases 0.000 description 1
- 230000001681 protective effect Effects 0.000 description 1
- 210000001835 viscera Anatomy 0.000 description 1
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Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0469—Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/0057—Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0482—Needle or suture guides
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/0057—Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect
- A61B2017/00637—Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect for sealing trocar wounds through abdominal wall
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/0057—Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect
- A61B2017/00646—Type of implements
- A61B2017/00663—Type of implements the implement being a suture
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0469—Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
- A61B2017/0472—Multiple-needled, e.g. double-needled, instruments
Definitions
- the present invention relates generally to medical devices, and systems for closing perforations in tissue.
- T-anchors also known as tissue anchors or visceral anchors.
- An exemplary tissue anchor is disclosed in U.S. Pat. No. 5,123,914 . Such tissue anchors have been very successful in medical procedures requiring visceral wall mobilization or wall apposition.
- U.S. Patent Application Publication No. 2001/021855 discloses a tissue fixation delivery system having the features of the preamble of claim 1.
- the present invention provides medical devices, and systems for placing tissue fixation devices that are easy to employ, reduce procedure time, and improve spacing of the tissue fixation devices.
- a medical device constructed in accordance with the teachings of the present invention, includes a plurality of elongate delivery devices, a plurality of elongate tubes, and a distal tip as determined by the appended claim 1.
- the delivery devices are needles, although other devices may be used for delivering tissue fixation devices.
- Each delivery device defines a delivery lumen sized to receive a tissue fixation device.
- the plurality of elongate tubes extend generally parallel to a longitudinal axis, and each tube defines a tube lumen sized to receive one of the delivery devices.
- Each tube lumen has a distal port.
- the distal tip is connected to the plurality of elongate tubes and defines a guide surface positioned distally of the distal ports.
- the guide surface is structured to redirect the plurality of delivery devices radially outwardly as the plurality of delivery devices are distally translated through the tube lumens and the distal ports of the plurality of elongate tubes.
- the guide surface slopes radially outwardly, and preferably is curved.
- the guide surface redirects the plurality of delivery devices in a direction angled relative to the longitudinal axis, preferably angled in the range of 10 to 60 degrees, and most preferably about 30 degrees.
- the distal tip defines a hub having a plurality of pockets sized to receive the plurality of elongate tubes. An end surface of the distal tip is atraumatically shaped.
- the delivery devices are puncture needles
- the tissue fixation devices are tissue anchors.
- a medical system for placing tissue fixation devices in bodily tissues includes a plurality of elongate delivery devices, a plurality of elongate tubes, a distal tip, and an endoscope.
- the plurality of delivery devices each define a delivery lumen sized to receive a tissue fixation device.
- the plurality of elongate tubes extend generally parallel to a longitudinal axis and each tube defines a tube lumen sized to receive one of the plurality of delivery devices.
- Each tube lumen defines a distal port.
- a distal tip is connected to the plurality of elongate tubes and defines a guide surface positioned distally of the distal ports and extending radially outwardly.
- the distal tip defines a passageway.
- the endoscope is selectively attachable to the distal tip, and the passageway is sized to receive a distal end of the endoscope therein.
- the medical device 20 generally includes a plurality of puncture needles 30 and a plurality of tubes 32.
- the plurality of needles 30 have at their proximal end a plurality of needle housings 34, while the proximal end of the plurality of tubes 32 includes a plurality of tube housings 36.
- the relative positions of the needle housings 34 and the tube housings 36 control the relative positions of the needles 30 within the protective tubes 32. In this manner, the needles 30 may be operated to project from a distal end of the tubes 32, or operated to be retracted within the tubes 32, as will be described in more detail hereinbelow.
- the distal tip 42 and plurality of tubes 32 may be interconnected through frictional engagement, adhesives, welding, soldering or any other well known means for connecting two structures.
- the hubs 44 define distal ports 55 through which the plurality of needles 30 extend and are exposed for placement through the bodily tissue 12. It will be recognized by those skilled in the art that the distal tip 42 may simply have the plurality of tubes 32 attached to its exterior surface, thereby eliminating the hub or hubs 44 and their pockets 46. In this case, the plurality of tubes 32 themselves would define the distal ports 55 though which the needles 30 can exit.
- the distal ports 55 are circumferentially spaced about the distal tip 42.
- the plurality of tubes 32 each define a tube lumen 58 which slideably receives the needles 30 therein.
- the needles 30 each define a needle lumen 52 which is sized to receive the stylet 40.
- a distal end 31 of each needle 30 contains one or more tissue anchors 54 positioned within the needle lumen 52.
- the distal end 31 also includes a slot 33 through which the suture 56 passes.
- the suture 56 is connected to the tissue anchor 54 and is used to draw the perforation 16 ( FIG. 7 ) closed, as is known in the art. It can be seen in FIG. 3 that the suture 56 extends proximally through the tube lumen 58 between the needle 30 and tube 32.
- the hubs 44 define slots 50 that open radially, and the slots 50 provide increased range of movement to the needles 30 as they flex.
- the plurality of tubes 32 are simply attached to the exterior surface of the distal tip 42 (i.e. without the hub 44 and pockets 46) these slots 50 may be formed in the tubes 32 themselves.
- the needles 30 enter the slots 50 defined by the hub 44 and pockets 46, thereby permitting greater range of movement and preventing excessive flexing or bending of the needles 30.
- the distal tip 42 and its guiding surface 64 move each of the needles 30 radially outwardly away from each other and away from the longitudinal axis 14. While the figures have depicted the guide surface 64 as curved, and generally a bell-shaped curve, it will be recognized by those skilled in the art that the guiding surface 64 may take many different curvatures, or can even be flat, such as in a conical or pyramidal shape (i.e. flat in the longitudinal direction). Further, the outer diameter of the distal tip 42 at its peak 65 may also be increased or decreased to increase or decrease the amount of deflection of the plurality of needles 30. The peaks 65 are preferably spaced radially outwardly of the distal ports 50.
- the distal tip 42 and its guiding surface 64 are structured to cause the needles 30 to be passed through the tissue 12 at an angle of about 10 to 60 degrees relative to the longitudinal axis 14.
- the needles 30 are at an angle of about 30 degrees relative to the longitudinal axis 14.
- the needles 30 are in paths that are circumferentially spaced apart, and preferably equidistantly spaced apart, thereby greatly improving the spacing of the tissue anchors 54 around a perforation 16 ( FIG. 7 ) and improving perforation closure.
- the plurality of puncture needles 30 are passed through the bodily tissue 12. This may occur sequentially or simultaneously. It will be recognized by those skilled in the art that because the distance between each of the needles 30 increases in the longitudinal direction (i.e. the more distal the greater the spacing), the medical system 22 and its distal tip 42 may be placed closer to the tissue 12 to bring the placement sites closer together, or the medical system 22 may be moved further away from the tissue 12 to increase the distance between the placement sites. In devices where other types of tissue fixation devices and delivery devices are employed (e.g. a visceral staple and delivery catheter, respectively) the delivery device need only be positioned proximate the tissue 12, and need not pass through the tissue 12.
- tissue fixation devices and delivery devices e.g. a visceral staple and delivery catheter, respectively
- the plurality of tissue anchors 54 are delivered to a position on the distal side of the bodily tissue 12.
- the tissue anchors 54 are connected to suture 56, and the anchors 54 are ejected from the distal end of the needles 30 through translation of the stylets 40 via depression of the plungers 38 ( FIG. 1 ).
- the plurality of puncture needles 30 are then retracted into the plurality of tubes 30, leaving the tissue anchors 54 in place.
- a cutting instrument 68 may then be delivered through the accessory channel 25 of the endoscope 24, and used to form an opening 16 in the tissue 12.
- the cutting tool 68 is an electrosurgical cutting instrument, although it will be recognized by those skilled in the art that any type of cutting instrument or device may be employed.
- the exemplary step of forming the opening 16 is performed after the exemplary step of translating the puncture needles 30 and most preferably after delivering the plurality of tissue anchors 54, thereby reducing the potential for the tissue 12 to deflect or move when placing the tissue anchors 54.
- the plurality of tissue anchors 54 or other tissue fixation devices may be delivered after the opening 16 has already been formed in the tissue 12. In either case, the tissue 12 (and sometimes the opening 16) is preferably visualized using the endoscope 24 prior to placing the plurality of puncture needles 30 through the bodily tissue 12.
- the medical system 22 may be retracted through the bodily lumen 10, and the endoscope 24 may be detached from the medical device 20. If desired, the endoscope 24 may then be reintroduced through the bodily lumen 10 and through the opening 16 in the bodily tissue 12. As such, various procedures may be employed with, or in conjunction with, the endoscope 24 on the distal side of the bodily tissue 12. It will also be recognized that various other medical devices may be passed through the bodily lumen 10 and through the opening 16 formed in the bodily tissue 12.
- the one or more sutures 56 attached to the tissue anchors 54 are connected together, such as by using a suture lock. Exemplary suture locks are disclosed in U.S. Patent Application Nos. 60/941,086 and 60/956,575 now published as WO 2008/147875 and WO 2009/026078 respectively. Through fixation of the sutures 56, the perforation 16 can be easily and securely closed.
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Description
- The present invention relates generally to medical devices, and systems for closing perforations in tissue.
- Perforations in the walls of internal organs and vessels may be naturally occurring, or formed intentionally or unintentionally. In order to permanently close these perforations and allow the tissue to properly heal, numerous tissue fixation devices and methods have been developed employing sutures, adhesives, clips, staples and the like. One class of such devices is commonly referred to as T-anchors, also known as tissue anchors or visceral anchors. An exemplary tissue anchor is disclosed in
U.S. Pat. No. 5,123,914 . Such tissue anchors have been very successful in medical procedures requiring visceral wall mobilization or wall apposition. - Tissue anchors have also been successfully used in closing perforations, but are not without their drawbacks. For example, when a series of anchors are placed around a perforation, each individual anchor is manually placed in sequence. This can be time consuming, and can result in uneven spacing of the anchors around the perforation. It can therefore be difficult to ensure proper approximation of the tissue around the perforation and complete closure thereof. This is especially critical within the gastrointestinal tract, where the travel of bacteria laden fluids outside of the tract may cause unwanted and sometimes deadly infection.
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U.S. Patent Application Publication No. 2001/021855 discloses a tissue fixation delivery system having the features of the preamble ofclaim 1. - The present invention provides medical devices, and systems for placing tissue fixation devices that are easy to employ, reduce procedure time, and improve spacing of the tissue fixation devices. One embodiment of a medical device, constructed in accordance with the teachings of the present invention, includes a plurality of elongate delivery devices, a plurality of elongate tubes, and a distal tip as determined by the appended
claim 1. Preferably the delivery devices are needles, although other devices may be used for delivering tissue fixation devices. Each delivery device defines a delivery lumen sized to receive a tissue fixation device. The plurality of elongate tubes extend generally parallel to a longitudinal axis, and each tube defines a tube lumen sized to receive one of the delivery devices. Each tube lumen has a distal port. The distal tip is connected to the plurality of elongate tubes and defines a guide surface positioned distally of the distal ports. The guide surface is structured to redirect the plurality of delivery devices radially outwardly as the plurality of delivery devices are distally translated through the tube lumens and the distal ports of the plurality of elongate tubes. - According to more detailed aspects of the medical device, the guide surface slopes radially outwardly, and preferably is curved. The guide surface redirects the plurality of delivery devices in a direction angled relative to the longitudinal axis, preferably angled in the range of 10 to 60 degrees, and most preferably about 30 degrees. The distal tip defines a hub having a plurality of pockets sized to receive the plurality of elongate tubes. An end surface of the distal tip is atraumatically shaped. Preferably, the delivery devices are puncture needles, and the tissue fixation devices are tissue anchors.
- A medical system for placing tissue fixation devices in bodily tissues is also provided. According to one embodiment of the medical system, the system includes a plurality of elongate delivery devices, a plurality of elongate tubes, a distal tip, and an endoscope. The plurality of delivery devices each define a delivery lumen sized to receive a tissue fixation device. The plurality of elongate tubes extend generally parallel to a longitudinal axis and each tube defines a tube lumen sized to receive one of the plurality of delivery devices. Each tube lumen defines a distal port. A distal tip is connected to the plurality of elongate tubes and defines a guide surface positioned distally of the distal ports and extending radially outwardly. The distal tip defines a passageway. The endoscope is selectively attachable to the distal tip, and the passageway is sized to receive a distal end of the endoscope therein.
- According to more detailed aspects of the medical system, the endoscope is loosely press fit within the passageway of the distal tip. The passageway defines an inner surface, and the inner surface is positioned to frictionally engage the endoscope. The plurality of tubes extend along an outer surface of the endoscope. The guide surface is structured to redirect the plurality of delivery devices radially outwardly as the plurality of delivery devices are distally translated through the tube lumens and the distal ports of the plurality of elongate tubes.
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FIG. 1 is a plan view, partially cut-away, showing a medical device constructed in accordance with the teachings of the present invention; -
FIG. 2 is a front view, partially in cross-section, showing a medical system including the medical device depicted inFIG. 1 , constructed in accordance with the teachings of the present invention; -
FIG. 3 is an enlarged cross-sectional view, partially cut away, of the distal end of the medical device depicted inFIG. 1 ; -
FIG. 4 is an enlarged cross-sectional view, partially cut away, of the distal end of the medical system depicted inFIG. 2 ; and -
FIGS. 5 ,6 and7 are enlarged cross-sectional views similar toFIG. 4 showing operation of the medical system. - Turning now to the figures,
FIG. 1 depicts amedical device 20 constructed in accordance with the teachings of the present invention. As shown inFIG. 2 , themedical device 20 also forms part of amedical system 22, which includes themedical device 20 and anendoscope 24. Generally, themedical device 20 is selectively attachable to theendoscope 24, and themedical system 22 may be traversed through a bodily lumen of a patient to a desired location for performing procedures within the body, such as at a particular bodily wall or tissue. As depicted inFIG. 2 , the bodily lumen may be theesophagus 10 while the bodily tissue may be thegastric wall 12, although themedical system 22 may be used with any bodily lumen and tissue, as will be understood by those skilled in the art. - Turning back to
FIG. 1 , themedical device 20 generally includes a plurality ofpuncture needles 30 and a plurality oftubes 32. The plurality ofneedles 30 have at their proximal end a plurality ofneedle housings 34, while the proximal end of the plurality oftubes 32 includes a plurality oftube housings 36. As is known to those skilled in the art, the relative positions of theneedle housings 34 and thetube housings 36 control the relative positions of theneedles 30 within theprotective tubes 32. In this manner, theneedles 30 may be operated to project from a distal end of thetubes 32, or operated to be retracted within thetubes 32, as will be described in more detail hereinbelow. The proximal end of themedical device 20 also includes a plurality ofplungers 38 which are connected to stylets 40 (FIG. 3 ) that extend through the plurality ofneedles 30. The stylets 40 (operated via their plungers 38) are used to push tissue fixation devices such as tissue anchors 54 (FIG. 3 ) out from the distal ends of theneedles 30. - With reference to
FIGS. 1 and3 , the plurality oftubes 32 are connected to adistal tip 42 at the distal end of thetubes 32. Thedistal tip 42 generally includes a plurality ofhubs 44 defining a plurality ofpockets 46 for receiving the plurality oftubes 32, as best seen inFIG. 3 . Thehubs 44 could be a single hub having a plurality ofpockets 46, or as shown inFIG. 2 , individual anddiscreet hubs 44 may be designed to define the plurality ofpockets 46. Eachhub 44 defines ashoulder 48 at the bottom of thepocket 46 for abutting a distal end of eachtube 32. Thedistal tip 42 and plurality oftubes 32 may be interconnected through frictional engagement, adhesives, welding, soldering or any other well known means for connecting two structures. Thehubs 44 define distal ports 55 through which the plurality ofneedles 30 extend and are exposed for placement through thebodily tissue 12. It will be recognized by those skilled in the art that thedistal tip 42 may simply have the plurality oftubes 32 attached to its exterior surface, thereby eliminating the hub orhubs 44 and theirpockets 46. In this case, the plurality oftubes 32 themselves would define the distal ports 55 though which theneedles 30 can exit. The distal ports 55 are circumferentially spaced about thedistal tip 42. Preferably the distal ports 55 are equidistantly spaced to provide for delivery of the tissue anchors 54 in a generally equidistantly spaced configuration, although different spacings may be designed, such as to match the shape of the perforation 16 (FIG. 7 ) in thetissue 12, which can be elongated or otherwise uneven, rather than circular. - As also best seen in
FIG. 3 , the plurality oftubes 32 each define atube lumen 58 which slideably receives theneedles 30 therein. Similarly, theneedles 30 each define aneedle lumen 52 which is sized to receive thestylet 40. A distal end 31 of eachneedle 30 contains one or more tissue anchors 54 positioned within theneedle lumen 52. The distal end 31 also includes a slot 33 through which thesuture 56 passes. Thesuture 56 is connected to thetissue anchor 54 and is used to draw the perforation 16 (FIG. 7 ) closed, as is known in the art. It can be seen inFIG. 3 that thesuture 56 extends proximally through thetube lumen 58 between theneedle 30 andtube 32. It will also be recognized by those skilled in the art that thesuture 56 could alternatively pass through the interior of theneedle 30, i.e., through theneedle lumen 52. The tissue anchors 54 may be pre-loaded within theneedles 30, and likewise the needles may be pre-loaded within the plurality oftubes 32, although this is not necessary. - Notably, various types and designs of tissue anchors 54 may be employed in conjunction with the present invention, exemplary tissue anchors being disclosed in
U.S. Patent No. 5,123,914 ; andU.S. Provisional Patent Application No. 60/872,023 , now published asWO 2008/067384 . It will also be recognized that themedical device 20 andmedical system 22 of the present invention may also be used in conjunction with other tissue fixation devices such as staples, an exemplary tissue staple and system being disclosed inU.S. Patent Application No. 60/956,580 , now published asWO 2009/026076 . Accordingly, it will be seen that the plurality of puncture needles 30 can be replaced with other elongate delivery devices, such as delivery catheters for tissue staples, dependent upon the particular tissue fixation device. - As best seen in
FIGS. 3 and4 , thedistal tip 42 includes aninterior passageway 60 defined by aninterior wall 62. As shown inFIG. 4 , thepassageway 60 andinterior wall 62 are sized to receive an endoscope therein for forming themedical system 22 of the present invention. In the depicted embodiment, thepassageway 60 andwall 62 are sized to be loosely press-fit with theendoscope 24 such that they are selectively attachable, although it will be recognized by those skilled in the art that many different structures and means for selectively attaching theendoscope 24 to themedical device 20 may be employed. Anend surface 66 of the distal tip is atraumatically shaped, i.e. rounded, such that themedical system 22 may be safely navigated through the patient's bodily lumens. - It can also be seen that the plurality of
tubes 32 and needles 30 generally extend along alongitudinal axis 14 that is also shared by thedistal tip 42. The plurality oftubes 32 are elongated and structured to extend longitudinally along the outer surface of theendoscope 24, as shown inFIG. 2 . Aband 23 or other structure may be used to connect the plurality oftubes 32 to theendoscope 24 at points along the length of themedical system 22, althoughsuch bands 23 or the like are not necessary to traverse themedical system 22 through thebodily lumen 10. It will also be recognized that theendoscope 24 can be integrally formed with themedical device 20, namely with the plurality oftubes 32 anddistal tip 42. For example, thedistal tip 42 and/or plurality oftubes 32 can be bonded to theendoscope 24, such as with an adhesive or using welding techniques. - An outer surface of the
distal tip 42 defines aguide surface 64. Generally, theguide surface 64 extends radially outwardly and is positioned distally of the distal port 55. As best seen inFIG. 5 , as the plurality ofneedles 30 are distally translated relative to the plurality oftubes 32, theneedles 30 project from the distal port 55 and engage theguide surface 64. Theguide surface 64 extends radially outwardly and deflects theneedles 30 radially outwardly, as indicated byarrow 70. As shown inFIG. 6 , upon further translation in the distal direction, theneedles 30 continue to flex and are directed radially outwardly. Thehubs 44 defineslots 50 that open radially, and theslots 50 provide increased range of movement to theneedles 30 as they flex. In an embodiment where the plurality oftubes 32 are simply attached to the exterior surface of the distal tip 42 (i.e. without thehub 44 and pockets 46) theseslots 50 may be formed in thetubes 32 themselves. As such, theneedles 30 enter theslots 50 defined by thehub 44 and pockets 46, thereby permitting greater range of movement and preventing excessive flexing or bending of theneedles 30. - Accordingly, the
distal tip 42 and its guidingsurface 64 move each of theneedles 30 radially outwardly away from each other and away from thelongitudinal axis 14. While the figures have depicted theguide surface 64 as curved, and generally a bell-shaped curve, it will be recognized by those skilled in the art that the guidingsurface 64 may take many different curvatures, or can even be flat, such as in a conical or pyramidal shape (i.e. flat in the longitudinal direction). Further, the outer diameter of thedistal tip 42 at its peak 65 may also be increased or decreased to increase or decrease the amount of deflection of the plurality ofneedles 30. The peaks 65 are preferably spaced radially outwardly of thedistal ports 50. Preferably, thedistal tip 42 and its guidingsurface 64 are structured to cause theneedles 30 to be passed through thetissue 12 at an angle of about 10 to 60 degrees relative to thelongitudinal axis 14. Most preferably, theneedles 30 are at an angle of about 30 degrees relative to thelongitudinal axis 14. Further, theneedles 30 are in paths that are circumferentially spaced apart, and preferably equidistantly spaced apart, thereby greatly improving the spacing of the tissue anchors 54 around a perforation 16 (FIG. 7 ) and improving perforation closure. - An exemplary method for placing tissue fixation devices in
bodily tissue 12 of a patient will now be described with reference toFIGS. 2 and5-7 . Amedical system 20 is provided, such as themedical device 20 andendoscope 24 as previously discussed. Theendoscope 24 is attached to themedical device 20, namely by placing the distal end of theendoscope 24 into theinterior passageway 60 of thedistal tip 42. Themedical system 20 is introduced through abodily lumen 10 of the patient to a position proximate thebodily tissue 12, as shown inFIG. 2 . The plurality of puncture needles 30 are translated distally through the plurality oftubes 32 such that the plurality ofneedles 30 engage theguide surface 64 and deflect radially outwardly, as shown inFIG. 5 and indicated byarrow 70. As shown inFIG. 6 , the plurality of puncture needles 30 are passed through thebodily tissue 12. This may occur sequentially or simultaneously. It will be recognized by those skilled in the art that because the distance between each of theneedles 30 increases in the longitudinal direction (i.e. the more distal the greater the spacing), themedical system 22 and itsdistal tip 42 may be placed closer to thetissue 12 to bring the placement sites closer together, or themedical system 22 may be moved further away from thetissue 12 to increase the distance between the placement sites. In devices where other types of tissue fixation devices and delivery devices are employed (e.g. a visceral staple and delivery catheter, respectively) the delivery device need only be positioned proximate thetissue 12, and need not pass through thetissue 12. - Once the plurality of puncture needles 30 have been passed through the
bodily tissue 12, as shown inFIG. 6 , the plurality of tissue anchors 54 are delivered to a position on the distal side of thebodily tissue 12. In the depicted example, the tissue anchors 54 are connected to suture 56, and theanchors 54 are ejected from the distal end of theneedles 30 through translation of thestylets 40 via depression of the plungers 38 (FIG. 1 ). As shown inFIG. 7 and indicated byarrow 72, the plurality of puncture needles 30 are then retracted into the plurality oftubes 30, leaving the tissue anchors 54 in place. - If desired, a cutting
instrument 68 may then be delivered through theaccessory channel 25 of theendoscope 24, and used to form an opening 16 in thetissue 12. Preferably, the cuttingtool 68 is an electrosurgical cutting instrument, although it will be recognized by those skilled in the art that any type of cutting instrument or device may be employed. Preferably, the exemplary step of forming the opening 16 is performed after the exemplary step of translating the puncture needles 30 and most preferably after delivering the plurality of tissue anchors 54, thereby reducing the potential for thetissue 12 to deflect or move when placing the tissue anchors 54. However, the plurality of tissue anchors 54 or other tissue fixation devices may be delivered after the opening 16 has already been formed in thetissue 12. In either case, the tissue 12 (and sometimes the opening 16) is preferably visualized using theendoscope 24 prior to placing the plurality of puncture needles 30 through thebodily tissue 12. - The
medical system 22 may be retracted through thebodily lumen 10, and theendoscope 24 may be detached from themedical device 20. If desired, theendoscope 24 may then be reintroduced through thebodily lumen 10 and through the opening 16 in thebodily tissue 12. As such, various procedures may be employed with, or in conjunction with, theendoscope 24 on the distal side of thebodily tissue 12. It will also be recognized that various other medical devices may be passed through thebodily lumen 10 and through the opening 16 formed in thebodily tissue 12. When the procedure(s) on the distal side of the opening 16 are complete, the one ormore sutures 56 attached to the tissue anchors 54 are connected together, such as by using a suture lock. Exemplary suture locks are disclosed inU.S. Patent Application Nos. 60/941,086 and60/956,575 WO 2008/147875 andWO 2009/026078 respectively. Through fixation of thesutures 56, the perforation 16 can be easily and securely closed. - The foregoing description of various embodiments of the invention has been presented for purposes of illustration and description. It is not intended to be exhaustive or to limit the invention to the precise embodiments disclosed. Numerous modifications or variations are possible in light of the above teachings. The embodiments discussed were chosen and described to provide the best illustration of the principles of the invention and its practical application to thereby enable one of ordinary skill in the art to utilize the invention in various embodiments and with various modifications as are suited to the particular use contemplated. All such modifications and variations are within the scope of the invention as determined by the appended claims when interpreted in accordance with the breadth to which they are fairly, legally, and equitably entitled.
Claims (12)
- A medical device (20) for placing tissue fixation devices (54) in bodily tissue (12), the medical device (20) comprising:a plurality of elongate delivery devices (30), each delivery device (30) defining a delivery lumen (52) sized to receive a tissue fixation device (54);a plurality of elongate tubes (32) extending generally parallel to a longitudinal axis (14), each tube (32) defining a tube lumen (58) sized to slidably receive one of the plurality of delivery devices (30), each tube lumen (58) ending proximate a distal port (55); anda distal tip (42) positioned distally of the distal ports (55), the outer surface of the distal tip (42) defines a guide surface (64) structured to redirect the plurality of delivery devices (30) radially outwardly as the plurality of delivery devices (30) are distally translated through the tube lumens (58) and the distal ports (55) of the plurality of elongate tubes (32);characterised in thatthe distal tip (42) defines one or more hubs (44) having a plurality of pockets (46) sized to receive the plurality of tubes (32), wherein the distal tip (42) and the plurality of tubes (32) are interconnected through frictional engagement, adhesives, welding or soldering.
- The medical device (20) of claim 1, wherein the guide surface (64) slopes radially outwardly.
- The medical device (20) of claim 1, wherein the guide surface (64) is curved.
- The medical device (20) of claim 1, wherein the guide surface (64) redirects the plurality of delivery devices (30) in a direction angled relative to the longitudinal axis (14).
- The medical device (20) of claim 4, wherein the guide surface (64) redirects the plurality of delivery devices (30) in a direction angled about 30 degrees relative to the longitudinal axis (14).
- The medical device (20) of claim 1, wherein the plurality of elongate tubes (32) are equidistantly spaced circumferentially about the distal tip (42).
- The medical device (20) of claim 1, wherein the plurality of delivery devices (30) include a plurality of puncture needles, and wherein the plurality of tissue fixation devices (54) include a plurality of tissue anchors.
- The medical device (20) of claim 1, wherein each hub (44) has a bore extending therethrough, proximal portions of the bores defining the pockets (46) and distal portions of the bores (50) defining the distal ports (55), and wherein each hub (44) defines a longitudinal slot (50) in communication with the bore and opening radially, each longitudinal slot (50) sized to receive one of the delivery devices (30) therein.
- The medical device (20) of claim 1, wherein each delivery device (30) slides within its elongate tube (32) independently of the other delivery devices (30).
- The medical device (20) of claim 1, wherein each hub (44) defines a shoulder (48) at the bottom of each pocket (46) for abutting a distal end of each of the plurality of tubes (32).
- A medical system (22) including the medical device (20) of any preceding claim and further comprising an endoscope (24) selectively attachable to the distal tip (42), wherein the distal tip (42) defines a passageway (60) sized to receive a distal end of the endoscope (24) therein.
- The medical system (22) of claim 11, wherein the plurality of tubes (32) extend along an outer surface of the endoscope (24).
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PCT/US2008/064508 WO2008147871A1 (en) | 2007-05-25 | 2008-05-22 | Medical devices, systems and methods for closing perforations |
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EP (1) | EP2155071B1 (en) |
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Families Citing this family (52)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US8758400B2 (en) | 2000-01-05 | 2014-06-24 | Integrated Vascular Systems, Inc. | Closure system and methods of use |
US9579091B2 (en) | 2000-01-05 | 2017-02-28 | Integrated Vascular Systems, Inc. | Closure system and methods of use |
US6391048B1 (en) | 2000-01-05 | 2002-05-21 | Integrated Vascular Systems, Inc. | Integrated vascular device with puncture site closure component and sealant and methods of use |
CA2421856A1 (en) | 2000-09-08 | 2002-03-14 | James E. Coleman | Surgical staple |
US6626918B1 (en) | 2000-10-06 | 2003-09-30 | Medical Technology Group | Apparatus and methods for positioning a vascular sheath |
US8690910B2 (en) | 2000-12-07 | 2014-04-08 | Integrated Vascular Systems, Inc. | Closure device and methods for making and using them |
US7905900B2 (en) * | 2003-01-30 | 2011-03-15 | Integrated Vascular Systems, Inc. | Clip applier and methods of use |
US6623510B2 (en) | 2000-12-07 | 2003-09-23 | Integrated Vascular Systems, Inc. | Closure device and methods for making and using them |
US6749621B2 (en) | 2002-02-21 | 2004-06-15 | Integrated Vascular Systems, Inc. | Sheath apparatus and methods for delivering a closure device |
ATE417549T1 (en) | 2002-06-04 | 2009-01-15 | Abbott Vascular Inc | SURGICAL CLAMP AND APPLICATION DEVICE FOR VESSEL WOUND CLOSURE |
US8905937B2 (en) | 2009-02-26 | 2014-12-09 | Integrated Vascular Systems, Inc. | Methods and apparatus for locating a surface of a body lumen |
US8398656B2 (en) | 2003-01-30 | 2013-03-19 | Integrated Vascular Systems, Inc. | Clip applier and methods of use |
US8202293B2 (en) | 2003-01-30 | 2012-06-19 | Integrated Vascular Systems, Inc. | Clip applier and methods of use |
US9713465B1 (en) * | 2004-04-19 | 2017-07-25 | Granit Medical Innovation Llc | Surgical closure device and associated method |
US8926633B2 (en) | 2005-06-24 | 2015-01-06 | Abbott Laboratories | Apparatus and method for delivering a closure element |
US8313497B2 (en) | 2005-07-01 | 2012-11-20 | Abbott Laboratories | Clip applier and methods of use |
US8556930B2 (en) | 2006-06-28 | 2013-10-15 | Abbott Laboratories | Vessel closure device |
US8893947B2 (en) | 2007-12-17 | 2014-11-25 | Abbott Laboratories | Clip applier and methods of use |
US9282965B2 (en) | 2008-05-16 | 2016-03-15 | Abbott Laboratories | Apparatus and methods for engaging tissue |
EP2344045A1 (en) * | 2008-09-16 | 2011-07-20 | Ventralfix, Inc. | Method and apparatus for minimally invasive delivery, tensioned deployment and fixation of secondary material prosthetic devices in patient body tissue, including hernia repair within the patient's herniation site |
EP2346411B1 (en) * | 2008-10-06 | 2013-10-02 | Cook Medical Technologies LLC | Endcap for safely deploying tissue anchors |
US9241696B2 (en) | 2008-10-30 | 2016-01-26 | Abbott Vascular Inc. | Closure device |
US9089311B2 (en) | 2009-01-09 | 2015-07-28 | Abbott Vascular Inc. | Vessel closure devices and methods |
US9414820B2 (en) * | 2009-01-09 | 2016-08-16 | Abbott Vascular Inc. | Closure devices, systems, and methods |
US20100179589A1 (en) | 2009-01-09 | 2010-07-15 | Abbott Vascular Inc. | Rapidly eroding anchor |
US9486191B2 (en) | 2009-01-09 | 2016-11-08 | Abbott Vascular, Inc. | Closure devices |
US9173644B2 (en) | 2009-01-09 | 2015-11-03 | Abbott Vascular Inc. | Closure devices, systems, and methods |
US20100185234A1 (en) | 2009-01-16 | 2010-07-22 | Abbott Vascular Inc. | Closure devices, systems, and methods |
CA2757494C (en) * | 2009-04-03 | 2013-11-12 | Cook Medical Technologies Llc | Medical devices, systems, and methods for rapid deployment and fixation of tissue anchors |
US20110054492A1 (en) | 2009-08-26 | 2011-03-03 | Abbott Laboratories | Medical device for repairing a fistula |
GB2486497B (en) * | 2010-12-17 | 2013-06-19 | Neosurgical Ltd | Laparoscopic trocar system |
US9855031B2 (en) | 2010-04-13 | 2018-01-02 | Neosurgical Limited | Suture delivery system |
US20150335320A1 (en) * | 2010-04-13 | 2015-11-26 | neoSurgical Ltd. | Suture delivery system |
WO2011156591A2 (en) | 2010-06-09 | 2011-12-15 | C.R. Bard, Inc. | Instruments for delivering transfascial sutures, transfascial suture assemblies, and methods of transfascial suturing |
ITPI20100099A1 (en) * | 2010-08-18 | 2012-02-19 | Enrico Gervasi | INNOVATIVE DEVICE FOR SURGICAL USE TO BE USED IN MUSCLE / TENDINE TRANSPLANTATION CARRIED OUT IN ARTHROSCOPY |
JP5615112B2 (en) * | 2010-09-21 | 2014-10-29 | 日本コヴィディエン株式会社 | Organ fixing device and organ fixing device |
GB2495534B (en) * | 2011-10-13 | 2014-04-23 | Neosurgical Ltd | Laparoscopic system |
US9826972B2 (en) | 2011-10-24 | 2017-11-28 | C.R. Bard, Inc. | Instruments for delivering transfascial sutures, transfascial suture assemblies and methods of transfascial suturing |
US9039721B2 (en) | 2011-11-07 | 2015-05-26 | C.R. Bard, Inc. | Instruments for delivering transfascial sutures and methods of transfascial suturing |
US9924938B2 (en) | 2011-11-07 | 2018-03-27 | C.R. Bard, Inc. | Instruments for delivering transfascial sutures and methods of transfascial suturing |
US9078648B2 (en) | 2011-11-07 | 2015-07-14 | C.R. Bard, Inc. | Instruments for delivering transfascial sutures and methods of transfascial suturing |
US9332976B2 (en) | 2011-11-30 | 2016-05-10 | Abbott Cardiovascular Systems, Inc. | Tissue closure device |
WO2013119630A1 (en) * | 2012-02-06 | 2013-08-15 | Cook Medical Technologies Llc | Artificial device deployment apparatus |
US9364209B2 (en) | 2012-12-21 | 2016-06-14 | Abbott Cardiovascular Systems, Inc. | Articulating suturing device |
JP6117160B2 (en) * | 2014-09-18 | 2017-04-19 | 本田技研工業株式会社 | Vehicle braking control device |
US9668725B2 (en) * | 2015-03-24 | 2017-06-06 | Richard B. Beaven | Laparoscopic wound closure device |
US10639020B2 (en) | 2015-09-28 | 2020-05-05 | M-V Arterica AB | Vascular closure device |
US11344292B2 (en) * | 2018-06-14 | 2022-05-31 | Covidien Lp | Trans-vaginal cuff anchor and method of deploying same |
US11375994B2 (en) * | 2019-07-12 | 2022-07-05 | Abbot Cardiovascular Systems, Inc. | Methods, systems, and devices for positioning sutures for closing an opening in tissue |
US20210068813A1 (en) * | 2019-09-06 | 2021-03-11 | Boston Scientific Scimed Inc. | Systems, suture devices, and methods for tissue closure |
JP2023503038A (en) | 2019-11-19 | 2023-01-26 | アーテリカ, インコーポレイテッド | Vascular closure device and method |
WO2023114840A1 (en) * | 2021-12-16 | 2023-06-22 | Hologic, Inc. | Colpotomy cup for faciliting suturing of vaginal cuff |
Family Cites Families (108)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US2199025A (en) * | 1936-06-08 | 1940-04-30 | Carl E Conn | Means and method of closing surgical incisions |
US3556079A (en) * | 1967-05-16 | 1971-01-19 | Haruo Omizo | Method of puncturing a medical instrument under guidance of ultrasound |
US4235238A (en) * | 1978-05-11 | 1980-11-25 | Olympus Optical Co., Ltd. | Apparatus for suturing coeliac tissues |
US5417691A (en) * | 1982-05-20 | 1995-05-23 | Hayhurst; John O. | Apparatus and method for manipulating and anchoring tissue |
US5123914A (en) * | 1986-05-19 | 1992-06-23 | Cook Incorporated | Visceral anchor for visceral wall mobilization |
ES2074130T3 (en) * | 1989-08-09 | 1995-09-01 | Bard Inc C R | GUIDE CATHETER SYSTEM AND CHUCKS FOR QUICK CATHETER EXCHANGE. |
US5203787A (en) * | 1990-11-19 | 1993-04-20 | Biomet, Inc. | Suture retaining arrangement |
US5366480A (en) * | 1990-12-24 | 1994-11-22 | American Cyanamid Company | Synthetic elastomeric buttressing pledget |
US5333624A (en) * | 1992-02-24 | 1994-08-02 | United States Surgical Corporation | Surgical attaching apparatus |
DE4235506A1 (en) * | 1992-10-21 | 1994-04-28 | Bavaria Med Tech | Drug injection catheter |
IL103737A (en) * | 1992-11-13 | 1997-02-18 | Technion Res & Dev Foundation | Stapler device particularly useful in medical suturing |
US5403348A (en) * | 1993-05-14 | 1995-04-04 | Bonutti; Peter M. | Suture anchor |
IT1269443B (en) * | 1994-01-19 | 1997-04-01 | Stefano Nazari | VASCULAR PROSTHESIS FOR THE REPLACEMENT OR INTERNAL COATING OF MEDIUM AND LARGE DIAMETER BLOOD VESSELS AND DEVICE FOR ITS APPLICATION WITHOUT INTERRUPTION OF BLOOD FLOW |
GB2298368B (en) * | 1995-02-22 | 1999-01-20 | John Francis Cockburn | Medical needle assembly for use in ultrasound imaging |
US5807304A (en) * | 1995-03-09 | 1998-09-15 | Cockburn; John F. | Medical needle for use in ultrasound imaging |
US6132438A (en) * | 1995-06-07 | 2000-10-17 | Ep Technologies, Inc. | Devices for installing stasis reducing means in body tissue |
US5690656A (en) * | 1995-06-27 | 1997-11-25 | Cook Incorporated | Method and apparatus for creating abdominal visceral anastomoses |
US5810848A (en) * | 1996-08-21 | 1998-09-22 | Hayhurst; John O. | Suturing system |
US6053871A (en) * | 1997-01-21 | 2000-04-25 | William Cook Australia Pty. Ltd | Calibrated hollow probe for use with ultrasound imaging |
US5891159A (en) * | 1997-05-02 | 1999-04-06 | Cardiothoratic Systems, Inc. | Automatic purse string suture device |
US5908428A (en) * | 1997-05-27 | 1999-06-01 | United States Surgical Corporation | Stitching devices for heart valve replacement surgery |
US6071292A (en) | 1997-06-28 | 2000-06-06 | Transvascular, Inc. | Transluminal methods and devices for closing, forming attachments to, and/or forming anastomotic junctions in, luminal anatomical structures |
US5954732A (en) * | 1997-09-10 | 1999-09-21 | Hart; Charles C. | Suturing apparatus and method |
US6078831A (en) * | 1997-09-29 | 2000-06-20 | Scimed Life Systems, Inc. | Intravascular imaging guidewire |
ES2228165T3 (en) * | 1998-12-09 | 2005-04-01 | Cook Incorporated | HOLLOW NEEDLE, CURVED, SUPERELASTIC, FOR MEDICAL USE. |
US6110183A (en) * | 1998-12-22 | 2000-08-29 | Cook Incorporated | Suture anchor device |
US7416554B2 (en) * | 2002-12-11 | 2008-08-26 | Usgi Medical Inc | Apparatus and methods for forming and securing gastrointestinal tissue folds |
US6398796B2 (en) * | 1999-07-13 | 2002-06-04 | Scion Cardio-Vascular, Inc. | Suture with toggle and delivery system |
JP4108882B2 (en) * | 1999-08-04 | 2008-06-25 | オリンパス株式会社 | Endoscope wall fixture |
US6358197B1 (en) * | 1999-08-13 | 2002-03-19 | Enteric Medical Technologies, Inc. | Apparatus for forming implants in gastrointestinal tract and kit for use therewith |
US6231561B1 (en) | 1999-09-20 | 2001-05-15 | Appriva Medical, Inc. | Method and apparatus for closing a body lumen |
US6635073B2 (en) * | 2000-05-03 | 2003-10-21 | Peter M. Bonutti | Method of securing body tissue |
US7399304B2 (en) | 2000-03-03 | 2008-07-15 | C.R. Bard, Inc. | Endoscopic tissue apposition device with multiple suction ports |
US6572629B2 (en) * | 2000-08-17 | 2003-06-03 | Johns Hopkins University | Gastric reduction endoscopy |
US6638275B1 (en) * | 2000-10-05 | 2003-10-28 | Medironic, Inc. | Bipolar ablation apparatus and method |
ATE443476T1 (en) * | 2001-05-18 | 2009-10-15 | Ucl Business Plc | FLEXIBLE DEVICE FOR PIERCING AND JOINING TISSUE |
US20030225312A1 (en) * | 2002-03-18 | 2003-12-04 | Anthony Kalloo | Endoscopic system for treating inside of body cavity |
US6699263B2 (en) * | 2002-04-05 | 2004-03-02 | Cook Incorporated | Sliding suture anchor |
US7494496B2 (en) * | 2002-05-17 | 2009-02-24 | Ucl Biomedica Plc | Device for transfixing and joining tissue |
JP4373146B2 (en) * | 2002-07-11 | 2009-11-25 | オリンパス株式会社 | Endoscopic suturing device |
US8070743B2 (en) * | 2002-11-01 | 2011-12-06 | Valentx, Inc. | Devices and methods for attaching an endolumenal gastrointestinal implant |
US20060015125A1 (en) * | 2004-05-07 | 2006-01-19 | Paul Swain | Devices and methods for gastric surgery |
US9314235B2 (en) * | 2003-02-05 | 2016-04-19 | Smith & Nephew, Inc. | Tissue anchor and insertion tool |
US7431694B2 (en) * | 2003-05-16 | 2008-10-07 | Ethicon Endo-Surgery, Inc. | Method of guiding medical devices |
JP4145200B2 (en) * | 2003-06-06 | 2008-09-03 | オリンパス株式会社 | Suture device |
US8216252B2 (en) | 2004-05-07 | 2012-07-10 | Usgi Medical, Inc. | Tissue manipulation and securement system |
US7481826B2 (en) * | 2003-09-30 | 2009-01-27 | Ethicon, Inc. | Fluid emitting suture needle |
US7217279B2 (en) * | 2003-11-14 | 2007-05-15 | Ethicon, Inc. | Suture loop anchor |
JP4217587B2 (en) | 2003-11-26 | 2009-02-04 | オリンパス株式会社 | Endoscope cap |
US7361180B2 (en) * | 2004-05-07 | 2008-04-22 | Usgi Medical, Inc. | Apparatus for manipulating and securing tissue |
JP4643451B2 (en) | 2004-01-08 | 2011-03-02 | オリンパス株式会社 | Anastomosis |
US20050154401A1 (en) * | 2004-01-08 | 2005-07-14 | Scimed Life Systems, Inc. | Suturing device for implantable device |
JP3799612B2 (en) * | 2004-03-22 | 2006-07-19 | 有限会社エスアールジェイ | Ultrasound endoscope device |
JP4643328B2 (en) * | 2004-04-07 | 2011-03-02 | オリンパス株式会社 | Medical ligature suturing device |
WO2006033671A2 (en) * | 2004-04-15 | 2006-03-30 | Wilson-Cook Medical Inc. | Endoscopic surgical access devices and methods of articulating an external accessory channel |
US7736374B2 (en) | 2004-05-07 | 2010-06-15 | Usgi Medical, Inc. | Tissue manipulation and securement system |
US8444657B2 (en) | 2004-05-07 | 2013-05-21 | Usgi Medical, Inc. | Apparatus and methods for rapid deployment of tissue anchors |
US7390329B2 (en) * | 2004-05-07 | 2008-06-24 | Usgi Medical, Inc. | Methods for grasping and cinching tissue anchors |
US20060004409A1 (en) * | 2004-05-14 | 2006-01-05 | Nobis Rudolph H | Devices for locking and/or cutting a suture |
US20060004410A1 (en) * | 2004-05-14 | 2006-01-05 | Nobis Rudolph H | Suture locking and cutting devices and methods |
US8475476B2 (en) * | 2004-06-01 | 2013-07-02 | Cook Medical Technologies Llc | System and method for accessing a body cavity |
US8206417B2 (en) | 2004-06-09 | 2012-06-26 | Usgi Medical Inc. | Apparatus and methods for optimizing anchoring force |
US7678135B2 (en) * | 2004-06-09 | 2010-03-16 | Usgi Medical, Inc. | Compressible tissue anchor assemblies |
US7931661B2 (en) | 2004-06-14 | 2011-04-26 | Usgi Medical, Inc. | Apparatus and methods for performing transluminal gastrointestinal procedures |
US20070265561A1 (en) * | 2004-06-22 | 2007-11-15 | Yeung Jeffrey E | Disc Shunt for Treating Back Pain |
US20060020274A1 (en) * | 2004-07-23 | 2006-01-26 | Usgi Medical Inc. | Manipulatable grasping needle |
US7975700B2 (en) * | 2005-02-08 | 2011-07-12 | Koninklijke Philips Electronics N.V. | System for adjustable tissue anchors |
JP4592007B2 (en) * | 2005-02-15 | 2010-12-01 | Hoya株式会社 | Object internal treatment device and object internal treatment system |
JP2006288755A (en) | 2005-04-11 | 2006-10-26 | Olympus Medical Systems Corp | Medical treatment device |
US8663236B2 (en) * | 2005-04-26 | 2014-03-04 | Usgi Medical Inc. | Transgastric abdominal access |
US20060237023A1 (en) * | 2005-04-26 | 2006-10-26 | Usgi Medical Inc. | Transgastric tubal ligation |
US9585651B2 (en) | 2005-05-26 | 2017-03-07 | Usgi Medical, Inc. | Methods and apparatus for securing and deploying tissue anchors |
US8628541B2 (en) | 2005-05-26 | 2014-01-14 | Usgi Medical, Inc. | Methods and apparatus for securing and deploying tissue anchors |
JP2008541952A (en) * | 2005-06-02 | 2008-11-27 | コーディス・コーポレイション | Device for closing the patent foramen ovale |
US20070038232A1 (en) * | 2005-08-12 | 2007-02-15 | Kraemer Stefan J M | Apparatus and method for securing the stomach to the diaphragm for use, for example, in treating hiatal hernias and gastroesophageal reflux disease |
US20070060929A1 (en) * | 2005-09-13 | 2007-03-15 | Norio Onishi | Treating implement cartridge of living body tissue |
US7722631B2 (en) * | 2005-09-28 | 2010-05-25 | Olympus Medical Systems Corporation | Method for suturing perforation |
US20070123840A1 (en) * | 2005-10-18 | 2007-05-31 | Usgi Medical, Inc. | Instrument assisted abdominal access |
US20070112362A1 (en) * | 2005-11-14 | 2007-05-17 | Olympus Medical Systems Corp. | Perforation suturing method |
US8728121B2 (en) * | 2006-01-13 | 2014-05-20 | Olympus Medical Systems Corp. | Puncture needle and medical procedure using puncture needle that is performed via natural orifice |
US20080255422A1 (en) * | 2006-01-13 | 2008-10-16 | Olympus Medical Systems Corp. | Medical device |
US20070219411A1 (en) * | 2006-01-13 | 2007-09-20 | Olympus Medical Systems Corp. | Overtube and endoscopic treatment system |
US8721657B2 (en) * | 2006-01-13 | 2014-05-13 | Olympus Medical Systems Corp. | Medical instrument |
ITMI20060443A1 (en) * | 2006-03-13 | 2007-09-14 | Ethicon Endo Surgery Inc | DEVICE FOR THE MANIPULATION OF BODY TEXTILE |
US7951161B2 (en) | 2006-05-09 | 2011-05-31 | Medrad, Inc. | Atherectomy system having a variably exposed cutter |
US20070270752A1 (en) | 2006-05-18 | 2007-11-22 | Labombard Denis | Multifunctional instrument introducer |
US7758598B2 (en) | 2006-05-19 | 2010-07-20 | Ethicon Endo-Surgery, Inc. | Combination knotting element and suture anchor applicator |
US7736376B2 (en) | 2006-07-05 | 2010-06-15 | Olympus Medical Systems Corp. | Living body wall fixing tool used in endoscope |
US8870916B2 (en) * | 2006-07-07 | 2014-10-28 | USGI Medical, Inc | Low profile tissue anchors, tissue anchor systems, and methods for their delivery and use |
US20080097152A1 (en) * | 2006-07-20 | 2008-04-24 | David Stefanchik | Braided endoscope accessories |
US7837455B2 (en) * | 2006-07-28 | 2010-11-23 | Ethicon, Inc. | Apparatus and method for making suture packages |
US8007432B2 (en) * | 2007-01-26 | 2011-08-30 | Ethicon Endo-Surgery, Inc. | Endoscopic accessory control mechanism |
US8460314B2 (en) * | 2007-02-26 | 2013-06-11 | Olympus Medical Systems Corp. | Application of procedure through natural orifice |
US20080208214A1 (en) * | 2007-02-26 | 2008-08-28 | Olympus Medical Systems Corp. | Applicator and tissue fastening method through natural orifice |
US7780702B2 (en) * | 2007-02-27 | 2010-08-24 | Olympus Medical Systems Corp. | Suture tool |
US8128657B2 (en) * | 2007-02-27 | 2012-03-06 | Olympus Medical Systems Corp. | Suture instrument |
US8308766B2 (en) * | 2007-02-27 | 2012-11-13 | Olympus Medical Systems Corp. | Endoscopic treatment instrument |
US7815662B2 (en) * | 2007-03-08 | 2010-10-19 | Ethicon Endo-Surgery, Inc. | Surgical suture anchors and deployment device |
WO2008112850A2 (en) * | 2007-03-15 | 2008-09-18 | Minos Medical | System and method for translumenal closure in natural orifice surgery |
US20080262525A1 (en) * | 2007-04-17 | 2008-10-23 | Usgi Medical, Inc. | Tissue penetration and grasping apparatus |
US7967741B2 (en) | 2007-05-01 | 2011-06-28 | Ethicon Endo-Surgery, Inc. | Endoscopic guide device |
US7967842B2 (en) | 2007-06-01 | 2011-06-28 | Ethicon Endo-Surgery, Inc. | Integrated securement and closure apparatus |
US8088062B2 (en) * | 2007-06-28 | 2012-01-03 | Ethicon Endo-Surgery, Inc. | Interchangeable endoscopic end effectors |
US8992569B2 (en) * | 2007-06-29 | 2015-03-31 | Ethicon Endo-Surgery, Inc. | Insertion device and method of use |
US8128592B2 (en) * | 2007-07-11 | 2012-03-06 | Apollo Endosurgery, Inc. | Methods and systems for performing submucosal medical procedures |
US8771314B2 (en) * | 2007-09-28 | 2014-07-08 | Ethicon, Inc. | Surgical anchor device |
US7998150B2 (en) * | 2007-09-28 | 2011-08-16 | Olympus Medical Systems Corp. | Suturing device |
US20090149714A1 (en) * | 2007-12-05 | 2009-06-11 | Frank Bonadio | Surgical devices and methods |
-
2008
- 2008-05-22 AU AU2008256823A patent/AU2008256823B2/en not_active Ceased
- 2008-05-22 JP JP2010510426A patent/JP5443341B2/en active Active
- 2008-05-22 EP EP08756124.7A patent/EP2155071B1/en active Active
- 2008-05-22 CA CA2688261A patent/CA2688261C/en not_active Expired - Fee Related
- 2008-05-22 US US12/125,475 patent/US9155532B2/en active Active
- 2008-05-22 WO PCT/US2008/064508 patent/WO2008147871A1/en active Application Filing
Also Published As
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AU2008256823B2 (en) | 2013-09-12 |
WO2008147871A1 (en) | 2008-12-04 |
US9155532B2 (en) | 2015-10-13 |
JP2010527744A (en) | 2010-08-19 |
US20080294001A1 (en) | 2008-11-27 |
CA2688261C (en) | 2013-04-30 |
CA2688261A1 (en) | 2008-12-04 |
JP5443341B2 (en) | 2014-03-19 |
AU2008256823A1 (en) | 2008-12-04 |
EP2155071A1 (en) | 2010-02-24 |
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